COVID-19 and myocardial infarction – Authors' reply

Abstract

We thank Daniel Caldeira and Fausto Pinto for their comments regarding our study1Katsoularis I Fonseca-Rodríguez O Farrington P Lindmark K Fors Connolly A-M Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study.Lancet. 2021; 398: 599-607Summary Full Text Full Text PDF PubMed Scopus (97) Google Scholar focusing on COVID-19 and myocardial infarction. We did acknowledge the difficulties in distinguishing between different types of myocardial injuries in the discussion. The International Classification of Diseases versions 9 and 10 unfortunately do not distinguish between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), which is a limitation of our study.1Katsoularis I Fonseca-Rodríguez O Farrington P Lindmark K Fors Connolly A-M Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study.Lancet. 2021; 398: 599-607Summary Full Text Full Text PDF PubMed Scopus (97) Google Scholar Because STEMI and NSTEMI have partly different clinical characteristics and pathophysiology, it is quite possible that one might be affected more by COVID-19 than the other, as Caldeira and Pinto observe. However, we do not believe that merely looking into coronary revascularisation procedures will provide clear answers, because the clinical decision to go through with these procedures might in itself be affected by the presence of COVID-19. We also observed an increased risk of ischaemic stroke, which shares some of the same pathophysiological features as myocardial infarction. Furthermore, the increase in the risk of myocardial infarction was of the same magnitude as for ischaemic stroke, for which the risk of inaccurate diagnosis codification was low. Therefore, the case of a connection between COVID-19 and cardiovascular events is strengthened. We declare no competing interests. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort studyOur findings suggest that COVID-19 is a risk factor for acute myocardial infarction and ischaemic stroke. This indicates that acute myocardial infarction and ischaemic stroke represent a part of the clinical picture of COVID-19, and highlights the need for vaccination against COVID-19. Full-Text PDF COVID-19 and myocardial infarctionIoannis Katsoularis and colleagues1 found that COVID-19 is a risk factor for myocardial infarction and stroke through self-controlled case series evaluation, a method that has been used to establish the risk of myocardial infarction associated with influenza infection.2,3 Regarding myocardial infarction, as the investigators recognised, one of the possible limitations of this research is the inaccurate diagnosis and codification of myocardial injury or myocarditis as myocardial infarction, particularly because the current myocardial infarction definition (and diagnostic methods) differ from the definition at the time of the registry outcome validation study. Full-Text PDF